During last night’s heated town hall, Rep. Lou Barletta (R-PA) took a principled stance against employing harsh rhetoric to “scare” seniors about the future of Medicare. Describing Paul Ryan’s plan for Medicare, Barletta said, “So whatever you hear, that seniors are going to lose their benefits, I’m telling you right now, it’s an outright lie“:

BARLETTA: This plan does nothing to affect anyone 55 years and older and I honesty, when we start doing things to scare senior citizens, when politicians do that to get elected, I believe they need to find a different occupation. Because if this is what you need to do to get yourself elected and to keep that job, I don’t believe you deserve that job.

But in his campaign against then-Rep. Paul Kanjorski (D-PA), Barletta relied on the very same kind of fear mongering rhetoric he now condemns to scare seniors about the cuts to Medicare in the Affordable Care Act. “[T]here are 165 provisions relating to Medicare in the healthcare reform law. These changes aren’t just going to affect future generations – they’re going to affect today’s senior citizens and near-seniors,” Barletta’s campaign website states. “Paul Kanjorski voted FOR this healthcare bill. He voted to cut Medicare by $500 billion, and he voted for all of the changes that will dramatically worsen the health care that seniors receive.” Barletta even used this catchy ad to attack Kanjorski, arguing that seniors would have to “dig deeper” into their pockets to purchase coverage. Watch it:

In reality, the health law does not cut the current Medicare budget, but slows growth in the program by removing approximately $500 billion from future spending over the next 10 years. The changes help stabilize the program by eliminating overpayments and slowly phasing in payment adjustments that encourage providers to deliver quality care more efficiently. As a result the law extends the life of the Medicare trust fund by 12 years and allows seniors to retain all of their guaranteed Medicare benefits.

Yesterday, Scott Keyes reported that Rep. Paul Ryan’s (R-WI) effort to sell his budget proposal was not going over well with conservative constituents in his district. During a town hall meeting in Milton, attendees booed Ryan for rejecting the notion that the top income earners should be taxed more.

Last night, Rep. Lou Barletta (R-PA) received a similarly hostile reception from constituents during a public forum in Carbon County, as he tried to (incorrectly) reassure the group that Ryan’s budget would not affect the Medicare benefits of those over the age of 55. “This plan does not do nothing to affect anyone 55 years or older,” he said. “When we start doing things that scare senior citizens, like politicians do that to get elected, I believe they need to find a different occupation.” But before Barletta could continue, 64-year-old Linda Christman raised her hand and argued that those under 55 would see an erosion of benefits. The exchange became heated as other constituents began yelling for the woman to “sit down“:

CHRISTMAN: “Excuse me, I’d like to get something off my chest. And that is, you seem to think that because I’m not affected I won’t care if my niece, my grandson, my child is affected. I do care. And what you’re doing with this Ryan budget is you’re taking Medicare and you’re changing it from a guaranteed health care system to one that is a voucher system where you throw seniors on the mercy of for-profit insurance companies. [...]

BARLETTA: “Well, I won’t destroy Medicare, Medicare is going to be destroyed by itself. You’re….”

CHRISTMAN: “I have a great way for you…”

CROWD: “Let him talk….Sit down!…Let him talk! SIT DOWN!”

MAN: “I agree with her. And you know what? Why don’t you tell me to sit down?!”

CROWD: SIT DOWN!

MAN: “She’s an American citizen….Why don’t you show some manners and shut your mouth and let her talk…Why don’t you grow up and stop acting like a bunch of little boys?”

Listen:

Under the Ryan plan, Americans under 55 would have to purchase coverage from an exchange of private insurers, which would receive a government voucher that depreciates over time. As the Congressional Budget Office (CBO) has pointed out in its analysis of the Ryan proposal, “a typical beneficiary would spend more for health care….[because] private plans would cost more than traditional Medicare because of the net effect of differences in payment rates for providers, administrative costs, and utilization of health care services.” “Second, the government’s contribution would grow more slowly than health care costs, leaving more for beneficiaries to pay.”

Seniors over 55 could also see changes in their traditional Medicare plans after 2022. Since those currently over 55 would be able to enroll in private coverage, insurers would have an incentive to lure away the healthiest beneficiaries (creating what’s known as a death spiral) and health care providers could abandon traditional Medicare patients for the higher reimbursement rates of private insurers.

David Gorn reports that The California Health Benefits Exchange board met for the first time yesterday, “the initial big step toward implementing the first reform-prompted insurance exchange in the nation.” In October, California became the first state to establish health care exchanges under the Affordable Care Act, following a Massachusetts’ approach of allowing the Exchange to bargain with insurance companies on behalf of consumers.

At yesterday’s meeting, the all-volunteer board selected an interim chair of the exchange board, an interim administrative director, and appointed a search and recruitment committee to find an executive director. Board members also stressed the importance of ensuring that the Exchange serve as an active purchaser of health insurance, emphasizing the need for “choice, value, and service.” The Exchange will be able to negotiate prices for a large volume of individuals and secure the kind of group discounts that large employers now enjoy. Like the exchanges operating in Massachusetts, California will have the authority to exclude inefficient insurers from the market and require issuers to meet certain minimum standards.

“The success of the Exchange will depend in large part on it’s ability to build on California’s history as an active purchaser in other areas of health and importing that experience to the exchange,” Peter Harbage — a health policy expert who attended the meeting — told me, stressing that California is in fact the only state that selectively contracts with hospitals through its Medicaid program. Harbage estimates that this kind of bargaining has saved the sate approximately $15 billion since 1982. “The exchange is a chance to build on that history and find ways to create an even more effective purchaser,” he said.

Progressives see California’s Exchange as model for the nation, but whether other states will adopt the active purchaser structure will likely depend more on political ideology than past models of success. While blue states may follow California’s lead, red states will most certainly prefer the approach championed by Utah, where consumers can compare a wide variety of health plans sold by any insurers that want to participate. Health advocates have dubbed Utah’s exchanges a “flee market,” in which customers are overwhelmed by a myriad of options — many of which provide inefficient or poor quality coverage. It “would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery,” Jon Kingsdale, the former director of the Massachusetts Connector Authority has said. “The Exchanges would be nothing more than an automated Yellow Pages.”

With the overwhelming majority of Americans saying they oppose Rep. Paul Ryan’s (R-WI) budget, Steve Benen has a good post reminding us that it was just last year “when Republicans decided that opinion polls are the single most important factor policymakers should consider, especially when dealing with controversial changes to the status quo.” Here they were arguing that President Obama should drop reform because the American people oppose it:

- SEN. JOHN CORNYN (R-TX): “The American people don’t want this bill, but our Democrat friends seem determined to jam it down their throat regardless, and I think there are going to be some very serious consequences.”

- SEN. LAMAR ALEXANDER (R-TN): “The American people thoroughly reject it. So, if [President Obama] is listening to the American people, they’ve said no to his bill.”

- SEN. JOHN MCCAIN (R-AZ): “The American people are very smart. That’s why two thirds of them want either stop or start over.”

- REP. ERIC CANTOR (R-VA): “What we are trying to do is find out why the president wants to continue to ignore the American people.”

Now they’re ignoring public opinion that’s far harsher than the opposition to the Affordable Care Act:

- 80 percent oppose cuts to Medicare or Medicaid, including 73 percent of Republicans and 75 percent of Independents. [McClatchy-Marist poll]

- 68 percent of Americans say the proposed GOP cuts unfairly favor some groups more than others. And seven in ten also believe the Republican budget will affect their families. [CNN]

- 65 percent oppose turning Medicare into a voucher program and if they’re told that the cost of private insurance for seniors will increase, 84 percent of Americans oppose the plan. [Washington Post/ABC News poll]

Recall that after the election, Senate Minority Leader Mitch McConnell (R-KY) outlined his party’s priorities in the aftermath of a strong showing in the midterm elections. “Republicans have a plan for following through on the wishes of the American people,” he said in a speech titled “Listening To The People Who Sent Us Here.” It starts with gratitude and a certain humility for the task we’ve been handed. It means sticking ever more closely to the conservative principles that got us here. It means learning the lessons of history. And, above all, it means listening to the people who sent us here. If we do all this, we will finish the job.”